An Issue for 2012

Paul Starr, a professor of sociology and public affairs at Princeton, is the author of ''The Social Transformation of American Medicine.'' He was a senior health policy adviser in the Clinton administration.

Updated April 4, 2011, 2:28 PM

Do the Republicans really expect to repeal the Patient Protection and Affordable Care Act if they win control of Congress this fall, or would they rather have an issue for 2012? I think they want and expect to use the legislation to rally their base through two election cycles.

If Republicans win Congress, they could seek a renegotiation of the law, but that's unlikely to happen.

President Obama would presumably veto any repeal in the next two years. But the major provisions of the act don’t go into effect until 2014. If the G.O.P. wins the presidency and Congress in 2012, the party still has time to undo the primary provisions of the law through a budget reconciliation bill in the first half of 2013.

Yes, some of the law’s provisions are going into effect now and will become solidly entrenched by then. Most of these are comparatively minor and will survive. But the legislation gives the executive branch considerable leeway in writing regulations, so a Republican administration in 2013 could rewrite and effectively nullify some established provisions that it cannot fully repeal.

Conceivably, if Republicans win control of Congress this fall, they could enter into negotiations with the White House to revise some of the law’s controversial aspects, like the requirement that individuals obtain health coverage, that is not scheduled to go into effect until 2014.

If Republicans win Congress, a renegotiation of the law might be the best outcome, and in a world of reasonable people, it could happen. But in America today, that is the equivalent of saying that the chances are exceedingly small.